Study focuses on bringing rural clinics, physicians together 

Dr. Dave Schmitz of the Family Medical Residency program conferring with a resident, Dr. Ashley Binder, about where in rural Idaho she might like to serve. (photo by Paul Hosefros)

Walter Knox Memorial Hospital in Emmett has a physician’s job open for the first time in a decade, and CEO Max Long knows he has to be careful how he fills it. Rural communities aren’t for everyone, and Long wants to hire someone who will stay for a long time.

So Long will be looking at more than just career qualifications. He’ll also seek a person who wants to live in the country and who loves the recreational opportunities that come with the area.

“There isn’t a whole lot going on here,” Long said. “If their interests are not going to coincide with what we offer, we don’t even waste our time or the physician’s time.”

Rural CEOs like Long are getting new help from family practice physician Dave Schmitz, a matchmaker of sorts when it comes to rural health care.

Schmitz, an associate director of rural family medicine at the Family Medicine Residency of Idaho, teamed up with researcher Ed Baker, director of the Center for Health Policy at Boise State University, to create a questionnaire to help assess which small rural hospitals are more likely to succeed in hiring and retaining physicians.

Idaho’s rural clinics, health centers and hospitals must work hard to find physicians, especially family practice doctors. The state is 49th in the nation for the number of physicians per capita, and most of those physicians are clustered in urban areas like Boise and Coeur d’Alene. Meanwhile, the state has the sixth-oldest physician workforce in the country.

Baker and Schmitz call their 50-question research tool the Community Apgar Questionnaire. The Apgar is a widely used health assessment for newborn children.

The community Apgar assesses what qualities in a small rural hospital can help it attract and retain doctors. It measures areas like guaranteed income; plans for capital investment; and Internet access. It also looks at quality of life issues, recreation, community receptiveness and appreciativeness, and the strength of the hospital as an employer.

“We really want to touch upon what causes Idaho to recruit and retain doctors,” Baker said. “It’s not about the money.”

By interviewing hospital CEOs, physicians in rural areas, and community members, Baker and Schmitz learned amenities like recreational opportunities, Internet access, income guarantees, hospital leadership, and plans for capital investment are important to prospective hires. It’s also important that communities be supportive of the hospital and physician.

Other important factors are good arrangements for moving patients to larger hospitals if necessary; local volunteer opportunities; strong perceptions of quality; loan repayment; and high quality inpatient care. Baker and Schmitz did not release individual data for the hospitals.

Factors that could steer would-be employees away included spousal dissatisfaction; C-sections (some physicians want to perform them and some do not); a lack of shopping and other services; poor schools; a lack of electronic medical records, minimal part-time work options, poor social opportunities, and a low regard from the community. Communities without a social worker or counseling team fared poorly in recruiting and retaining family doctors.

The findings are not new to long-time hospital CEOs like Long.

He recalls a physician’s wife take the prospective hires’ wives shopping at the Boise mall.

“That’s what they were interested in,” he said. “If the spouse isn’t happy, they’re not going to stay.”

A decade ago, he said, he took a prospective doctor whitewater kayaking.

“We took him up to the south fork of the Payette, and I think that is what finally sold him,” Long said. That physician still works at Walter Knox.

Baker and Schmitz recently won a contract to carry out similar research in Wyoming, and last week they heard from officials in Wisconsin who also are interested.

Ultimately, they would like their questionnaire to be used around the country. Baker said among other things he’s sure the tool could help Idaho’s rural economies grow stronger.

“Without the provision of health care, no one is ever going to move in and create any business or industry in an area,” Baker said.

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